摘要目的：探讨环氧酶（ COX）?2选择性抑制剂对胆总管结石患者预防内镜逆行胰胆管造影术（ERCP）术后胰腺炎（PEP）、高淀粉酶血症的效果。方法入选朝阳医院2014年6月至2015年2月行ERCP术的患者128例，以随机双盲的方法按术前给予不同预防 PEP 药物分为联合用药组（ n＝33）、塞来昔布组（ n＝34）、硝酸甘油组（ n＝32）和对照组（ n＝29），并行ERCP检查，记录术后血清淀粉酶（AMS）、C反应蛋白（CRP）、直接胆红素（Dbil）、腹痛情况及PEP、ERCP术后高淀粉酶血症发生率。结果对于 PEP 发生率，联合用药组及塞来昔布组均低于硝酸甘油组及对照组（3?03％、2?94％比15?63％、17?24％），但差异无统计学意义（ P＝0?078），联合用药组及塞来昔布组术后高淀粉酶血症发生率低于对照组（3?03％、5?88％比31?03％），差异有统计学意义（P＝0?003，P＝0?010）；硝酸甘油组（25?00％）与对照组比较，差异无统计学意义。联合用药组及塞来昔布组术后腹痛等级低于硝酸甘油组、对照组，差异有统计学意义（P＜0?05），使用塞来昔布有助于降低术后CRP（P＝0?001），硝酸甘油有助于降低术后Dbil（ P＝0?016）。结论塞来昔布可减少ERCP 术后高淀粉酶血症的发生，改善术后腹痛及炎症反应程度，硝酸甘油有助于降低术后Dbil。

abstractsObjective To study the effects of cyclooxygenase( COX)?2 selective inhibitors on post?endoscopic retrograde cholangiopancreatography ( ERCP ) pancreatitis ( PEP ) and hyperamylasemia for common bile duct stones. Methods A total of 128 patients with normal serum amylase underwent ERCP from June 2014 to February 2015 in our hospital and were given corresponding drugs to prevent PEP.The pa?tients were divided randomly into four groups:combination group( n=33) , celecoxib group( n=34) , nitro?glycerin group(n=32) and control group(n=29). The serum amylase(AMS), C?reactive protein(CRP) and direct bilirubin( Dbil) after ERCP were measured. Abdominal pain was observed, and the incidence of PEP and post?ERCP hyperamylasemia were recorded. Results The incidence of PEP in combination group, celecoxib group were lower than those in nitroglycerin group and the control group ( 3?03%, 2?94% VS 15?63%, 17?24%),but the difference was not statistically significant(P=0?078).The incidence of post?ERCP hyperamylasemia in combination group and celecoxib group were lower than that in the control group ( 3?03%,5?88% VS 31?03%) with statistically significant difference( P=0?003, P=0?010) . There was no significant difference between nitroglycerin group ( 25%) and control group. The abdominal pain grades of combination group and celecoxib group were lower than those in nitroglycerin group and control group with significant difference(P<0?05). Celecoxib may reduce CRP after ERCP(P=0?001) and nitroglycerin may reduce Dbil after ERCP(P=0?016). Conclusion Celecoxib may reduce the incidence of hyperamylasemia&nbsp;and can help to reduce the abdominal pain and inflammatory reactions after ERCP . Nitroglycerin can help to reduce the Dbil after ERCP .